Phentermine and Qsymia - What You Need to Know About These Weight Loss Medications
Did you know there are weight loss medications other than Wegovy and Zepbound?
With these medications in high demand—and challenges like cost, access, and supply—it’s no surprise people are exploring other options.
This week, we’re diving into a medication that hasn’t gotten enough attention from me, despite my being a huge advocate and prescriber of it my whole career. That medication is Phentermine, as well as its combination with topiramate, known as Qsymia.
I’ll be talking about both of these medications, along with similar ones. These weight loss medications—formally called anti-obesity medications—have been around for a long time and remain a great option for many people.
So, welcome to the Phentermine and Qsymia episode! We’ll explore who can take these medications, who shouldn’t, what to expect, and how they compare to the newer, more powerful options. By the end, you’ll hopefully have a better understanding of these medications and whether they could be a good option for you or your patients.
Why Phentermine Could Be a Game-Changer in Weight Loss Treatment
Phentermine is an affordable option, which is a big reason it’s worth considering. Depending on location and available pharmacy discounts, it typically costs between $12 and $15 per month. When compared to more expensive medications like Wegovy or Zepbound, or even some weight loss supplements, Phentermine is a budget-friendly choice for many.
As a generic medication with over 60 years of use, Phentermine has established itself as a reliable option for managing obesity. Its affordability often leads patients to try Phentermine first before exploring newer, more costly medications.
Phentermine works differently than newer medications like Wegovy and Zepbound. While there aren’t studies on combining them, and it’s not FDA-approved for such use, there’s no significant contraindication for most people. For those who struggle with snacking or emotional eating, Phentermine could even be a helpful addition to treatments like Wegovy or Zepbound. While these newer options work well for many, Phentermine’s ability to curb appetite can support overall weight management efforts.
Is Phentermine or Qsymia Right for You? A Guide to Long-Term Use
Phentermine and Qsymia are two well-known medications in weight management, designed to assist individuals struggling with obesity or related health conditions. Phentermine, approved in 1959, is one of the oldest anti-obesity medications, while Qsymia combines Phentermine with Topiramate for enhanced effectiveness.
These medications are used to help individuals achieve weight loss by suppressing appetite, making it easier to maintain a calorie deficit. They are intended to be part of a broader treatment plan that includes dietary changes and regular physical activity.
Initially approved for short-term use, Phentermine has since been recognized as a safe option for long-term management in suitable candidates. Modern guidelines highlight that obesity is a chronic condition requiring sustained care. For individuals who tolerate Phentermine well, experience no significant side effects, and achieve at least 5% weight loss, ongoing use is often recommended.
Similarly, Qsymia provides a longer-term option for those who benefit from its dual-action formula. Both medications require proper medical supervision to ensure safety and effectiveness.
Phentermine and Qsymia remain valuable tools in the fight against obesity, offering hope for long-term weight management. When combined with lifestyle changes, these medications can help individuals achieve lasting results. However, their success depends on a comprehensive approach to health that prioritizes sustainable habits alongside medical support.
Understanding Phentermine: How It Works and Who It's For
Phentermine belongs to a category of medications called sympathomimetic amines, which are part of the stimulant class. It’s often compared to medications like Adderall or Vyvanse, used for ADHD, but it’s not as strong or stimulating. In fact, many describe its effects as similar to having a couple of cups of coffee.
The Drug Enforcement Agency (DEA) classifies Phentermine as a Schedule IV controlled substance, meaning it has a low potential for abuse or addiction. Despite being available for over 65 years, there’s little evidence of widespread abuse. Most patients report that it simply helps them manage their appetite more effectively.
Many people find they’re less preoccupied with food and can manage smaller portions or avoid impulsive snacking. For example, someone who might previously have felt the need for a mid-morning snack may find themselves effortlessly making it to lunch.
Typically, Phentermine is taken in the morning to avoid interfering with sleep, as it has stimulating properties. Patients are encouraged to eat balanced meals throughout the day, as the medication’s effects often wear off by evening. For those who drink coffee, cutting back on caffeine while starting Phentermine can help avoid feeling overstimulated.
In short, Phentermine can be an effective tool for appetite control and weight management when used as part of a balanced approach. With proper medical guidance, it can help reduce food cravings and support healthier eating habits. Always consult your doctor to see if it’s the right option for you.
Who Should and Shouldn’t Use Phentermine
Phentermine isn’t suitable for everyone. People with certain medical conditions, such as uncontrolled high blood pressure, hyperthyroidism, glaucoma, or a history of stimulant abuse, may need to avoid it. Similarly, it’s not recommended for those who are pregnant, breastfeeding, or have untreated pulmonary hypertension.
For individuals with controlled high blood pressure or a history of caffeine sensitivity, a discussion with a healthcare provider is crucial. Starting with a lower dose can also help ease concerns about potential side effects.
Some of the most common side effects of Phentermine include dry mouth, mild increases in heart rate, and occasional difficulty sleeping. While rare, some people might experience irritability, nervousness, or constipation. However, these side effects often subside after the first few days.
The Power of Phentermine and Topiramate Combination
Phentermine combined with Topiramate, often in the brand-name medication Qsymia, is a more effective treatment for weight loss than Phentermine alone. On average, Phentermine by itself supports approximately 7% weight loss, though individual results can vary. Some patients, referred to as "Phentermine responders," experience more substantial weight loss, even exceeding 20%. These individuals often pair the medication with strong adherence to nutritional and exercise habits, using Phentermine as a helpful support.
In contrast, the combination of Phentermine and Topiramate tends to result in slightly higher weight loss, averaging around 10% in many cases. Some patients achieve weight loss as high as 15% to 20% with this combination.
Topiramate, the additional component, introduces its own set of potential side effects. These include numbness and tingling, known as paresthesia, which are most common in the fingers but can occur elsewhere in the body. Such sensations are reported in as many as one in three patients. While they typically resolve once the medication is stopped, they can be bothersome.
Another possible side effect of Topiramate is brain fog, although this is less likely when using the low doses found in Qsymia. Some individuals may still experience mental cloudiness that affects their preference for continuing the medication. Additionally, Topiramate can increase the risk of kidney stones, so it may not be suitable for individuals with a history of kidney stones, as prevention becomes a priority.
A critical consideration with Topiramate is its known risk of causing birth defects, particularly cleft palate. Therefore, it is not recommended for those who are pregnant or may become pregnant. Women of reproductive age taking Topiramate should use reliable contraception to avoid this risk. Discussing birth control options with a healthcare provider is essential before starting this medication.
As with any medication, it is vital to ensure the combination is safe and appropriate for individual circumstances. Patients should consult a healthcare provider who can carefully review their medical history and any concurrent medications to confirm that this treatment is a good fit.
Alternative Medications to Phentermine
There are a few other medications in the sympathomimetic amine class that are similar to Phentermine and can be options depending on individual needs and tolerances. One such medication is Diethylpropion, which is also a Schedule IV controlled substance like Phentermine. It works in a comparable way but might be a better fit for some patients who experience side effects with Phentermine, such as headaches or irritability. If someone struggles with these issues, Diethylpropion could potentially provide relief without causing the same discomfort.
Another couple of options in this class, though less commonly prescribed, are Benzphetamine and Phendimetrazine. These medications are considered stronger alternatives and may be recommended when Phentermine isn’t effective or leads to unwanted side effects. While not as widely used as Phentermine or Diethylpropion, they can offer a more potent approach to appetite suppression for those who need it.
What makes these medications appealing is not just their effectiveness but also their affordability. Despite being older options, they continue to play a role in helping patients manage their weight and appetite as part of a broader treatment plan. Always consult with a healthcare provider to determine the best option based on individual health needs and goals.
I hope this episode gave you valuable insight into Phentermine and Qsymia, and how they compare to newer weight loss medications. Whether you’re considering these options for yourself or guiding your patients, remember that every treatment plan should be tailored to individual needs and goals. Consult with a healthcare provider to find the most effective and safe approach for weight management. Thanks for joining me today, and be sure to tune in for more discussions on treatments that could make a difference on the journey to better health.
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